Catalysing progressive uptake of newer diagnostics by health care providers through outreach and education in four major cities of India

Autor: Catharina Boehme, Ashwani Khanna, Syed Hissar, Bibhas Saha, Aakshi Kalra, Sreenivas Achuthan Nair, Kanwaljit Chopra, Sunil D. Khaparde, K. R. Umadevi, Virender Singh Salhotra, Neeraj Raizada, Sanjay Sarin, M. Hanif, C. H. Surya Prakash, Claudia M. Denkinger, Soumya Swaminathan, Raghuram Rao
Rok vydání: 2017
Předmět:
Bacterial Diseases
Medical Doctors
Health Care Providers
Psychological intervention
lcsh:Medicine
Pilot Projects
Disease
Pediatrics
Geographical Locations
0302 clinical medicine
Health care
Medicine and Health Sciences
Medicine
030212 general & internal medicine
Medical Personnel
lcsh:Science
Child
Multidisciplinary
Public sector
Community-Institutional Relations
Outreach
Professions
Infectious Diseases
Tuberculosis Diagnosis and Management
Private Sector
Pediatric Infections
Research Article
medicine.medical_specialty
Tuberculosis
Asia
Health Personnel
030231 tropical medicine
India
03 medical and health sciences
Tuberculosis diagnosis
Diagnostic Medicine
Physicians
Humans
Cities
Public Sector
business.industry
lcsh:R
medicine.disease
Private sector
Tropical Diseases
Health Care
Family medicine
People and Places
lcsh:Q
Population Groupings
business
Zdroj: PLoS ONE
PLoS ONE, Vol 13, Iss 3, p e0193341 (2018)
ISSN: 1932-6203
Popis: Background Unlike in adults, diagnosis of TB can be challenging in children, as signs and symptoms of paediatric TB can be very non-specific and similar to other common childhood chest infections, which may lead to under or delayed diagnosis of TB disease. In spite of the increasing availability of rapid high-sensitivity diagnostics in public and private sectors, majority of paediatric TB cases are empirically diagnosed, without laboratory confirmation. To address these diagnostic challenges, World Health Organization (WHO) has recommended upfront Xpert MTB/RIF (Xpert) testing for the diagnosis of TB in paediatric presumptive pulmonary and extra-pulmonary TB (EPTB) cases. However, in spite of the increasing availability of rapid high-sensitivity diagnostics, a significant gap exists in its application with Xpert being rarely used as an upfront diagnostic among patients presumed to have TB. Under an ongoing paediatric project since April 2014, which provided free-of-cost upfront Xpert testing, several low-cost outreach and education interventions were undertaken to increase the diagnostic uptake by different providers catering to the paediatric population, thereby increasing adherence to global guidance. Methods Providers catering to paediatric population in the project cities were systematically mapped and contacted using different outreach strategies. The focus of outreach efforts was to increase provider literacy and increase their awareness of the availability of free rapid diagnostic services with the goal of changing their diagnostic approaches. Results From April 2014 to June 2016, more than 5,700 providers/facilities were mapped and 3,670 of them were approached. The number of providers/facilities engaged under the project increased more than 10-fold (43 in April, 2014 to 466 in June, 2016), with significant increase in project uptake, both from public and private sector. Overall 42,238 paediatric presumptive TB cases were enrolled in the project, across the four cities. Over the project period, quarterly diagnostic uptake and paediatric TB cases detection rates increased more than two-fold. TB detection rates were similar in patients from public and private sectors. Conclusions Ongoing efforts in scaling up new rapid diagnostics involves significant investments. These efforts need to be complemented with proactive provider engagement to ensure provider-literacy and awareness, for maximizing impact of this scale-up. The current project demonstrated the usefulness of outreach and education interventions for the effective uptake of newer diagnostics.
Databáze: OpenAIRE
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